Gluten Sensitivity /Celiac Disease

Gluten Sensitivity / Celiac Disease: Overview

Alternative Names: Also classified as a disease of nutrient malabsorption, celiac disease is also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy.

Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten (or a gluten fraction called gliadin), which is found in wheat, rye, barley, and possibly oats.

Gluten is a protein found in wheat, rye, barley, and oats that gives dough it's sticky quality. An inability to digest these grains is called celiac disease.

Incidence; Causes and Development; Contributing Risk Factors

Approximately 0.5% of Americans have symptoms brought on by this condition. About 10% of an affected person's first-degree relatives (parents, siblings or children) will also have the disease. It has also been estimated that up to 20% of Americans have the disease to some degree.

When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Specifically, tiny fingerlike protrusions, called villi, on the lining of the small intestine are lost. Nutrients from food are absorbed into the bloodstream through these villi. Without villi, a person becomes malnourished – regardless of the quantity of food eaten.

There is increasing evidence that most people with gluten sensitivity have latent celiac disease with such mild manifestations in the digestive tract that the diagnosis is never made. An allergy or intolerance to specific grains, such as wheat, may be due to a gluten sensitivity, but may occur for other reasons as well.

Celiac disease is considered an autoimmune disorder because the body's own immune system causes the damage.

Celiac disease runs in families. Sometimes the disease is triggered by surgery, pregnancy, childbirth, viral infection or severe emotional stress. Celiac disease affects people differently; some develop symptoms as children, others as adults. One factor thought to play a role in when and how celiac appears is whether and how long a person was breastfed – the longer one was breastfed, the later and more atypical the symptoms appear. Other factors include the age at which one began eating foods containing gluten and how much gluten has been eaten.

Signs and Symptoms

Symptoms may or may not occur in the digestive system. For example, one person might have diarrhea and abdominal pain, while another person has irritability or depression.

Diagnosis and Tests

To diagnose celiac disease, physicians test blood to measure levels of antibodies to gluten. These antibodies are antigliadin, anti-endomysium and antireticulin. If the tests and symptoms suggest celiac disease, the physician may remove a tiny piece of tissue from the small intestine to check for damage to the villi. Gluten sensitivity should not be self-diagnosed, since other medical problems could be the cause of similar symptoms. A gluten-free diet should not be followed until you have been seen by your doctor. Tests for celiac disease cannot produce a proper diagnosis if a person is not currently reacting to gluten in their diet. Once a diagnosis is made and a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct.

Screening for celiac disease involves testing asymptomatic people for the antibodies to gluten/gliadin. Because celiac disease is hereditary, family members – particularly first-degree relatives – of people who have been diagnosed may need to be tested for the disease.

Complications

While the gastrointestinal tract is the primary target organ, systemic disease is an important consequence of gluten ingestion in many patients. Latent disease may manifest itself as irritable bowel syndrome with iron deficiency anemia, but little or no diarrhea. There is increasing evidence that most people with gluten/gliadin sensitivity have latent celiac disease with such a mild manifestation that the diagnosis is never made. The undamaged part of their small intestine is able to absorb enough nutrients to prevent symptoms. However, people without symptoms are still at risk for the complications of celiac disease.

The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications.

Some patients diagnosed SLE may in fact be suffering the results of gluten intolerance. In these cases, removing gluten from the diet may completely cure the patient. [Annals of the Rheumatic Diseases (2004; 63: pp1501-3)]

People with celiac disease are more likely to develop AutoimmuneThyroid Disease (ATD) than the general public, and the reverse is also true. Consuming gluten triggers an autoimmune process in those with celiac disease, causing the immune system to attack the body itself. In the case of ATD, the target of the attack is thyroid gland, resulting in a deficiency or excess of hormones, which causes unpredictable metabolic changes. The most common type of ATD is hypothyroidism.

In one study, 83 patients with autoimmune thyroid disorder were screened for celiac disease. Three patients with asymptomatic celiac disease were found along with one who had previously been diagnosed, giving an overall frequency of 4.8%. By contrast, only one of 249 age- and sex-matched blood donors was found to have celiac disease.

Childhood

Circulation

Anemia is a frequent presentation of celiac disease. In one study, 200 consecutive patients of a hematology clinic were screened for antigliadin and antiendomysial antibodies. Patients with both positive titers underwent intestinal biopsy, and in 10 patients (5%), results were positive for celiac disease. The prevalence increased to 8.5% if the patients with macrocytic anemia and the patients with bleeding who responded to iron therapy were excluded.

Digestion

Infections

In a study of 15 patients, 7 patients responded completely and two partially to diets excluding gluten (3 patients), azo compounds (3), milk (2), azo and milk (1). Two failed to respond and three failed to complete the diet. Responses were confirmed by re-challenge. The patients in this study had relatively severe aphthous ulcers. Gluten enteropathy had been excluded by biopsy in the patients who responded to the gluten-free diet. [B Med J 1986; 292: pp.1237-8]

Mental

Musculo-Skeletal

A study concluded that reduced mineralization occurs even in asymptomatic celiac patients, and that early diagnosis and treatment can prevent bone demineralization. [Am J Gastroenterol 1994;89: pp.2130-4]

Nervous System

Blood tests for gluten sensitivityantibodies were performed on 783 patients referred for seizures. In 36 patients who also had clinically evident celiac disease, no further seizures were noted after treatment with a gluten-free diet. In a second group of 9 patients, celiac disease was not recognized because of mild or absent symptoms, but the diagnosis was confirmed by jejunal biopsy. [Lancet 1992;340: pp.439-43]

Symptoms - Allergy

Tumors, Malignant

Gluten sensitivity predisposes patients to the eventual development of lymphoma. If this relationship is re-stated as "cereal grains cause cancer" the implications are more easily understood. In addition, the incidence of undiagnosed celiac disease is higher among those with small-bowel lymphoma [Eur J Gastroenterol Hepatol 2000;12: pp.645-8]. There is evidence that strict adherence to a gluten-free diet will reduce the incidence of lymphoma.

Risk factors for Gluten Sensitivity / Celiac Disease:

Autoimmune

Family History

Relatives of people with Type 1 Diabetes, as well as the sufferers themselves, run a 5% risk of developing celiac disease. When people affected by celiac disease eat wheat the immune system reacts by destroying the lining of the intestine. If these people avoid wheat the intestine heals; however, most people are asymptomatic and the untreated condition may bring about anemia, decreased growth and malignancy of the intestine if untreated.

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Gluten Sensitivity / Celiac Disease suggests the following may be present:

Autoimmune

Gluten Sensitivity / Celiac Disease can lead to:

Digestion

Gluten Sensitivity / Celiac Disease could instead be:

Mental

Studies have shown celiac disease to be inordinately high in "schizophrenic" populations. Research removing gluten and dairy products (which often seems to add to the problem) from the diet of a locked ward resulted in a significant improvement of patient behavior.

Recommendations for Gluten Sensitivity / Celiac Disease:

Amino Acid / Protein

Diet

The only treatment for celiac disease is to follow a gluten-free diet. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet, and the small intestine is usually completely healed in 3 to 6 months. Healing may take up to 2 years for older adults.

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